声学定量评价一氧化氮吸入对心功能的影响及其在估计心外科手术预后中的意义

通过对２４例心脏病合并肺动脉高压欲行心外手术的连续患者，一氧化氮（ＮＯ）吸入后不同期连续多普勒和声学定量检测发现，根据吸入ＮＯ后患者的反应情况，可将分为ＮＯ敏感组和不敏感组，两组患者的肺动压及左右室心功能各项指标在ＮＯ吸入后均有不同程度改善，但ＮＯ敏感组改善程度高于ＮＯ不敏感组。研究还发现，ＮＯ不敏感组７例中，５例患者心脏手术后无１例生存，有了前５例的经验，后２例患者我们未予手术。与此对照，ＮＯ敏感组手术均顺利。术后心脏功能代偿较满意，无１例死亡

Evaluation of Nitric Oxide Inhalation on Effect of Cardiac Function by Acoustic Quantification and Its Significance in Assessing the Prognosis of Patients Undergone Cardiac Surgery

Twenty-four patients with heart diseases associated with pulmonary hypertension were studied by acoustic quantification(AQ)during nitric oxide inhalation(NOI).End diastolic area(EDA),end systolic area(ESA),fractional area change(FAC),peak filling rate(PFR)and peak ejection rate(PER)of left ventricle(LV)and right ventricle(RV)were measured by AQ before NOI and after NOI 5min,10min,15min and 20min.The patients were divided into two groups according to the response to NOI.The results were shown that:1.Pulmonary pressure decreased in both groups after NOI 5min,NOI sensitive group decreased>35%(f=52 91),NOI non sensitive group decreased 17%(f=11 63).2.All cardiac functional indexes of both LV and RV began to improve after NOI 5min in NOI sensitive group. The degree of improvement was higher in RV than in LV(increasing 42% in RV and 36% in LV after NOI 20min).With improvement of LVFAC and RVFAC,LVEDA gradually decreased.In contrast,LVFAC began to increase(14%)after NOI 10min and maintain in this level in NOI non sensitive group.But no changes occurred for LVEDA.3.Five of seven patients died after cardiac surgery in NOI non sensitive group.Two patients did not perform on operation because of high risks.However,none of patients died after cardiac surgery in NOI sensitive group.